Decolonizing Indigenous health starts at universities. What needs to change at the U15?

A new report suggests that Canadian universities are falling short on advancing Indigenous health research and promoting drug accessibility for Indigenous communities

By Max Crosby and Celine Huang

Indigenous health is a Canadian public health crisis. Universities hold a pivotal position in advancing Indigenous health, but do they make the most of it? Our newly released report at Universities Allied for Essential Medicines (UAEM), the 2023 Canadian Global Health Grades, suggests that the U15 are falling short.

Issues in Indigenous health are multifactorial. The legacy of colonialism, as well as weak government policy, stand as the normative culprits. These problems start with the Canadian government. The Canadian parliament has never developed a law around improving Indigenous health. The closest they came was with the 2004 10 Year-Plan—a framework centered around prioritizing Indigenous health in policy—which categorically failed to improve health for Indigenous communities in Canada.

When this plan expired, no legislation was enacted to replace this health plan, de-prioritizing Indigenous health at the federal level and displaying a lack of commitment to improve Indigenous health from the federal government. The disparities in Indigenous health extend beyond government policy, though, and are deeply intertwined with systemic colonial practices in Canada. Distinct paradigms of both Western biomedical research and health policy exclude the Canadian Indigenous populations, with interpersonal and institutional racism serving as further barriers to health equality in Canada.

With the notable failures of the Canadian government and healthcare systems to effectively address current problems in Indigenous health, the critical role of universities in Indigenous health is often left overlooked.

Addressing Indigenous health disparities is tightly linked with the education of Indigenous peoples. Colonial stereotypes permeate the Canadian healthcare system, leading healthcare professionals to view Indigenous patients and Indigenous health issues through these biased lenses. From this, proposed improvements to the Canadian healthcare system center around increasing the number of Indigenous health practitioners and improving Indigenous health education.

The Canadian U15 universities, as higher-education institutions, can lead the way in fulfilling this, through making education accessible for Indigenous communities. Programs that do this exist at some universities, in the form of scholarships and specific entrance pathways for Indigenous students.

Such programs make education more accessible for marginalized and under-represented demographics and ensure that Indigenous voices and perspectives are present in policy making decisions, as well as future healthcare research and delivery. Altogether, eight of the Canadian U15 universities have programs to maximize Indigenous student enrollment in health-related programs.

While it is commendable that the majority of the U15 have programs aimed at increasing Indigenous participation in higher education, these programs must exist at every U15 institution.

In addition to boosting Indigenous participation in health research, it is imperative that Canadian universities actively provide socially-informed, decolonized education to its students, who are future generations of doctors, researchers, and policy makers. Yet, 11 of the U15 universities do not offer courses relating to decolonized approaches to global health, indicating a limited inclusion of Indigenous knowledge, practice and perspective in education at the Canadian U15.

Along with education in the Indigenous community, research innovation is integral to improving Indigenous health, through identifying solutions to problems particular to Indigenous communities. As stewards of the Canadian research ecosystem, Canadian universities have the opportunity to lead the way in this research.

Despite the fact that in the 2021 census 1.8 million people identified as Indigenous (about 5% of the Canadian population), U15 universities have neglected Indigenous health research. In fact, only 0.25% of publications from Canadian U15 universities touched on Indigenous health or Indigenous health strategies in the past two calendar years.

This relative lack of research is detrimental, given the presence of emerging issues in Indigenous research like climate change, neglected aspects of Indigenous research, and an insufficient knowledge base for Indigenous health research.

Parallel to research innovation, drug accessibility is another additional source of inequality in Indigenous health. Universities, typical innovators and patent holders for health technologies, are influential in this. The licensing agreements universities make with pharmaceutical producers act as direct determinants of drug prices. The provisions for drug access outlined in these agreements can positively influence the availability of these drugs in Canada and across the globe by requiring licensees to ensure affordable at-cost or generic versions of patented drugs for particular communities.

However, universities in Canada largely do not require licensing agreements to promote drug access to university patented-medicines in low income communities, like Indigenous communities, present in high income countries. Two-thirds of universities were found to employ licensing agreements that limit access to university patented technologies in low income communities in high income nations.

While unique pharmacare exists for Indigenous groups, as outlined in the drugs and pharmacy benefits for First Nations and Inuit, many drugs covered are solely available in a “limited use” format. With this, high costs associated with medicine serve as a reason to reduce its accessibility. University considerations towards drug accessibility could serve to alleviate this issue for essential university patented medicines for Indigenous populations in Canada.

Universities have a significant position in Indigenous health, through their roles in research, education and drug development. With their influence in these three domains, universities have the potential to act as leaders in improving Indigenous health across Canada. Moving forward, universities must leverage their roles in research and drug development to both increase the body of knowledge on Indigenous health policy and practice and to maximize access of patented drugs in Indigenous communities.

Read UAEM's Canadian Global Health Grades Report

Currently an undergraduate student at McGill University, Max has led the 2023 Canadian Report Card since the project was restarted in the Fall of 2020. Max is interested in the intersection of university biomedical R&D policy with access to medicines, and focuses on that in his work with UAEM

Celine is currently an undergraduate student at McGill University studying cognitive science. She first got involved with the report card in January 2022 during the data collection period and continued to work on the Report Card through a summer internship and at UAEM McGill. Since then, her work on the report card has primarily been focused on writing the 2023 Canadian Report Card White Paper.